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Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.
Fuente Ministerio de Interior de España

miércoles, 29 de mayo de 2024

What is IFAK? Is the Individual First Aid Kits (IFAK) for Traumatic Wounds ¿Que es IFAK? Su traduccion del ingles Kit de Primeros Auxilios Individuales para heridas traumaticas. by Dr. Ramon Reyes, MD

Mini IFAK Contents (Contenido Mini IFAK)
Equipos médicos versión MINI, en el caso de los Mini-IFAK, es ideal para personal de protección de dignatarios "VIP" y agentes encubiertos, todos depende que tanto queremos llevar y que tanto queremos ocultar el equipo que podría se la ultima esperanza del protegido o la mía misma. by Dr. Ramon Reyes, MD 
Medical equipment MINI version, in the case of the Mini-IFAK, it is ideal for close protection of "VIP" dignitaries and undercover agents, it all depends on how much we want to carry and how much we want to hide the equipment that could be the last hope of the protected or mine myself.

Mini IFAK Contents (Contenido Mini IFAK):

  • TK-4L Rugged Combat Tourniquet
  • QuikClot Advanced Clotting Sponge
  • WoundStop Home Care First Aid Wound Dressing
  • 3” x 18” Petrolatum Gauze
  • 4” x 6 yds. Compressed Gauze
  • Waterproof Combat Tape
  • Pair Medical Gloves (XL) 
What is IFAK? Is the Individual First Aid Kits (IFAK) for Traumatic Wounds     ¿Que es IFAK? Su traducción del ingles Kit de Primeros Auxilios Individuales para heridas traumáticas. by Dr. Ramon Reyes, MD

While I was at SOFIC I spent some time with the Raven Concealment Systems and CLEER Medical guys going over their new MBOK (Mini BlowOut Kit). Later, after I started reading the comments left on Facebook under MBOK-related posts, I went and spent some more time with them. You see, the MBOK may be the most maligned piece of gear to come out in a long time. I’ve posted a screenshot below to give you an sample; you’ll see many more examples once I put this article up on Facebook. Many of them will be from people who are responding to just the image and the MSRP, which is unfortunate – not because I’m an MBOK apologist, but because I think all declamations should be based on all available information.

But I digress.
The MBOK is a miniaturized IFAK (Individual First Aid Kit) that can be worn on your belt as an “EDC” item or in/on gear as a lightweight replacement for one of the many other medical kits out there (many of which are very good kits, all of which are substantially larger). It retails for anywhere from $249.99 to $329.99, with the possibility of $20.00 off if you preorder.

I will leave it to you to determine if it’s worth the MSRP.
The MBOK is comprised almost completely of proprietary individual components, each developed specifically to streamline and lighten the kit (this is plays no small part in the price). The contents are kept inside a medical “wallet” that fits inside a tubular “sleeve” designed so you can deploy the contents up or down. The kit contains all of what most would consider your “first line” trauma gear for immediate response to something like a gunshot wound, shy of applying a TQ (tourniquet), which you can carry alongside the MBOK in a Eleven 10 Rigid TQ Case. There is a reason why the TQ is not included in the MBOK. We’ll get to that eventually.
This is an evolved version of what we first looked at after SHOT back in January. Although the contents have remained consistent, the pouch itself is much different. There are 2 types of MBOK – basic and advanced. The difference lies in the contents of the wallet, not the sleeve. Inside the basic kit are a NAR (North American Rescue) dressing built specifically for the MBOK, a proprietary CELOX Rapid ribbon, dual chest seals (so you can address both entry and exit wounds), 3M medical tape and tan bear claw gloves. The advanced wallet includes a Rusch nasal pharyngeal airway with lube and chest dart (14 gauge x 3.25″). The initial MBOKs will be in a MOLLE pouch built of Blue Force Gear’s Helium Whisper and Ultracomp, with the option to pick up the rigid TQ case (built by Eleven 10, carried by CLEER) and an RCS paddle. In the very near future there will be additional mounting options available.
Each piece of the kit, from the gloves (which were chosen in brown to better show the results of a blood sweep) to the medical tape (which is in pre-cut strips), was selected, sized and packaged after much deliberation. The end goal was a comprehensive medical kit that takes up the absolute minimum amount of real estate.
Mini IFAK Contents (Contenido Mini IFAK)

Trauma Response Kit "Bag"

Planning your IFAK Packing List
JANUARY 15, 2020
One thing you figure out quickly in Army Special Forces is that if you get a bigger rucksack, you will always find things to put in it: Whether those things need to be there or not. The same thing happens if you buy a bag to use as an Individual First Aid Kit (IFAK) before planning what you are going to pack in it.
The best way to select an IFAK bag or any aid bag is to determine and plan the packing list first, then find a bag that will fit the items on your very thoughtfully selected packing list.
To plan an IFAK, which by definition will be a small “personal” bag, you have to decide which injuries you are planning on managing and which you are not. It should be placed for easy access in an emergency and so where you store it is also important.
Our IFAK plan is for managing immediately life-threatening injuries that can be handled with minimal equipment during an ongoing dangerous event. That is the mission statement in our TC2 course. Our IFAK packing list supports that mission statement.
Based on WDMET data, which drove the entire concept of TCCC, we plan on providing life-saving interventions (LSIs) only. Bandaids don’t go in an IFAK: They go in a “Boo Boo kit”. You don’t want somebody pulling things out of your IFAK looking for a band-aid. For this reason, we sometimes refer to IFAKs as trauma kits to make the difference between the two clear. Note: Crisis Medicine does not receive financial compensation for any recommendations regarding gear or equipment. 
Management of Life Saving Interventions: M-A-R-C-H
LSIs pertinent to an IFAK include the management of junctional and extremity hemorrhage, management of airway occlusion, decompression of tension pneumothorax, and prevention of hypothermia. Other more advanced interventions like iV access for shock require too much gear for an IFAK. 

If you plan on managing massive hemorrhage from an extremity, you will be using tourniquets. In any study ever conducted on human thighs, verifying occlusion of arterial flow with Doppler ultrasound, the CAT always outperforms any competitors. [For reasons not to buy them on Amazon, see our article on counterfeits]. We only have CAT tourniquets in our IFAKs packing lists. Admittedly, we are still using 6th generation CATS as they are the most proven. Unfortunately, their manufacture ceased in 2015. The 7th generation has now replaced them. There is literature to show it works, but not as much data as previous generations. We remain cautiously optimistic. Since one tourniquet high on a thigh may only occlude arterial flow 70% of the time, you need to have two available. That will bump the efficacy to at least 80% success. If you have more than one casualty, you can quickly run out of commercial tourniquets: Having a plan to improvise isn’t poor planning, it’s professional.
Wound Packing
If two properly applied tourniquets placed side by side don’t control your massive extremity bleeding you will need to wound pack. Additionally, junctional hemorrhage, from necks, groins, armpits, and potentially subclavian vessels will not be amenable to tourniquet placement and also require skills and knowledge of wound packing. 
The best way to pack a wound will be with gauze. In my Army Special Forces career, no advanced hemostatic type agents existed, and we routinely packed significant junctional wounds with cotton Kerlix gauze. Unfortunately, you can go through a lot of gauze packing a wound. Studies show plain old Kerlix gauze works just as well as the current hemostatic gauzes if you know what you are doing. These items also go on our IFAK packing list.
Hemostatic Gauze
A hemostatic gauze with some scientific evidence it works may help less trained/experienced wound packers. Of the commercially available hemostatic gauzes, Combat Gauze has the most evidence supporting its use. If you can afford to add it to your IFAK, that seems reasonable. 
Unless you plan on continuing to hold pressure on a tightly packed wound until the casualty is taken to definitive care, you will need to know how to make a wound packing bandage. The last thing you want is for the gauze in the tightly packed wound to work its way loose and have the person start bleeding to death all over again. Wound packing bandages require a lot of materials. 
Airway intervention is not terribly likely in combat casualties based on the WDMET data, accounting for about 1.6% of deaths. Half will only require simple positioning, think head-tilt chin-lift, and the recovery position. In this situation, a nasal pharyngeal airway can be helpful. The other half of airway interventions statistically will be for direct airway injuries. In that instance, a surgical airway will frequently be the answer and is a paramedic level skill. 
The minimal equipment needed to decompress a tension pneumothorax is something sharp to make a hole in the chest wall to let out the air under tension. Although you can do this with a knife (which is basically a finger thoracotomy) having a large needle and catheter can make it easier. This too is a Paramedic level skill in most states. There is no good evidence that an open pneumothorax really needs to be sealed. Since we have limited space in an IFAK, we don’t have chest seals there. 
More advanced interventions like iV/iO access require too much gear for an IFAK.Circulation management with an IFAK largely involves keeping the “red stuff in.” (By controlling hemorrhage).
Hypothermia Prevention
Equipment for the prevention of hypothermia isn’t especially IFAK friendly. The NAR HPMK or PerSys Blizzard transport system are awesome options for a vehicle-mounted bag, but much too large for an IFAK. Having an inexpensive “space blanket” is the best option in a small kit. 
Standardization of IFAKs
All of the IFAKS in my home, cars, and tactical gear are packed identically. They differ only in color. IFAKs are not location-specific, they are casualty specific to deal with LSIs, so there is no reason to change what is in the IFAK. The plan for the IFAK remains consistent. Obviously, my medical skill set is more advanced than my wife or teenage daughter, but the IFAK they may grab out of the car is loaded the same, in case I am there to use it.
How big is your IFAK?
The IFAK loadout below does make for a pretty big IFAK. With a smaller skill set or scope of practice, items can be omitted. My wife routinely carries a smaller, easy access IFAK in her purse that is primarily designed to deal with massive hemorrhage and thus a smaller packing list: 2 CAT tourniquets, two rolls of z-folded compressed gauze, a vacusealed pack containing a cravat, a 4×7 individual first aid dressing and 4” ETD, a windlass, shears, and gloves. 
Based on the packing list I use, the only IFAK that is big enough to hold everything is the Condor Tear Away IFAK (model MA41). There are currently two sizes, and we use the larger. This IFAK bag is cheaply made, but also inexpensive. It seems to hold up fine and when it shows too much wear, I replace the bag. We have students do all the casualty scenarios in our in-person Advanced class with this IFAK and a similar packing list (that class doesn’t cover surgical airways, so those materials aren’t included). 
IFAK Load Out/Packing List based on LSIs:
(2) military safety pins from military cravats
NPAs – although the “universal” size is 28 French, I have one sized for each family member
A single serving packet of water-soluble lubricating jelly for the NPAs – it just makes insertion easier
(2) Tourniquets, taken out of the plastic wrap
A very small roll of 100-MPH tape
A vacusealed bag containing:
(2) rolls of Kerlix 4.5 inches x 4.1 yards
(2) military cravats
A military 4×7 Individual First Aid Dressing
A 4 inch ETD / Israeli bandage
a preplanned wooden windlass
(2) rolls military or LEO Combat Gauze 
(2)10-14 gauze 3.25 inch angiocaths
A surgical airway kit consisting of: 
mosquito forceps
a cut down endotracheal tube, 6.5 mm
a disposable #10 scalpel
a length of gutted 550-cord to secure the ETT
A 10 cc syringe
A space blanket
That’s it. 
But you left out the ####
Some people will say why don’t you carry [fill in their favorite medical gadget]. The reason is simple. These items allow me to run the MARCH mnemonic on any patient, especially my family. It’s not going to be enough for a mass casualty event because even local fire and ambulance services do not carry enough gear for a mass casualty event. Studies differ on how many casualties occur in active violent incidents. North American Rescue’s public access bleeding control kit comes as an 8-pack of sub-kits because they use data suggesting there are seven casualties per event. There is FBI data suggesting the number may be 4. 
The final block of the Crisis Medicine Complete Tactical Casualty Care course is a 1-hour whiteboard discussion where we make a packing list for an IFAK, an aide bag, and a vehicle-mounted bag. Want to learn how to use everything on this packing list? Online classes available.

Individual First Aid Kit IFAK by Dr. Ramon Reyes, MD 

Pues en España tenemos unos """"EXPERTOS"""" como los llamo yo, expertos de escritorio,,, que dicen que han leido mucho de esto y por eso ellos no trabajan en entorno tactico, lo primero es que no quieren llamarlo ATAQUE TERRORISTA... Cada cosa se llama por su nombre y no existe otra forma de llamar a este tipo de situaciones desafortunadas que vivimos hoy en dia.
Me hago una preguna ¿Que pasara con esa madre amputada?
¿Que pasara con ese maestro con un pneumotorax?, ¿Que pasara con el que muera por obstruccion de via aerea ahogado en su propia sangre?
Mi pregunta es ¿Se negaron a acturar los SEMs en Barcelona? Cuando decidi ser medico me comprometi a salvar vidas, cuando decidi ser callejero lo hice por conviccion personal, me encanta ver como personas que se la pasan tonteando en las redes sociales, o vendediendose como expertos en la materia, a la hora de la verdad bailan como Michael Jackson hacia detras,,, no veo seriedad, ni mucho menos compromiso, en aquel que me diga que le teme a un tiro en un situacion de peligro, pero sin embargo pincha el acelerador de la ambulancia sin medir consecuencias y sin pensar en sus familiares. Pues Yo digo y repito, primero enterese que es Medicina Tactica, luego enterese cuales son las fases de actuacion con multiples victimas en situaciones tacticas (pero repito LEA) y luego se pasea por las redes sociales vendiendo fotos de que eres un experto en algo que inclusive los mas basico ignoras. les remito una de las que me han dicho en defensa de quedarse comiendo palomitas de maiz mientras las victimas en esas circunstancias mueren o empeoran ( es que no quiero que me peguen un tiro) y cuando le recrimino las falta de informacion esta es su respuesta...
Pues me han dicho, "mis asesores leen mucho", y yo le contesto a esas personas, Mis asesores, escriben lo que leen tus asesores...
Trauma Response Kit "Bag"

Me da la impresión que lo que existe en todo esto es una mala interpretación de las intervenciones del personal Sanitario (Medico) Civil en entorno Táctico Y esta muy bien definido a nivel internacional, por ejemplo en los EUA esto sucede a diario y los paramédicos (EMS), no hemos tenido ni fatalidad, ni incidentes al respecto.... El Personal Sanitario en Entorno Táctico, Lleva su EPI (ver fotos adjuntas) especial como los periodistas, que se colocan chaleco y casco antibalas, asi como botas y guantes resistentes y nunca sin protección ocular... Ahora bien no intervenimos en donde existe fuego cruzado, solo en entornos barridos por el 1º Equipo de Contacto (función neutralizar la amenaza, NO ATIENDEN VICTIMAS, no es su mision) ¿Saben todos que es neutralizar Amenaza? les contesto pues ellos no van a conversar con el atacante para nada... Pues lo dicho entramos en el 2º Equipo de Rescate, a sacar y tratar victimas (Pero siempre protegidos por el 2º equipo, que tiene las mismas condiciones y entrenamientos que el equipo 1º "Contacto"), ellos salvaguardan nuestra seguridad, y si no entramos por la razón que sea,,,, aumentara la mortalidad por las famosas muertes prevenibles, Hemorragias Extremidades, Neumotórax, Obstrucción Vías Aéreas, etc... les dejo este simple análisis,, que no me invento, es lo que dicen los que saben,,, por favor no matar al mensajero. Ahora bien si USTED, no tiene el entrenamiento, ni tiene ni idea de esto, no se invente un curso por favor y desinforme a tantos ilusos que tenemos en este medio...

Dr. Ramon Reyes, MD​
Tactical Medical Specialist-USA
Ex-Tte de Navio Medico de la Armada
PHTLS-TECC-TCCC Facultado Internacional
Medico Especialista en Misiones de Alto Riesgo y Zonas Hostiles
Colegiado en España


TACMED Spain Medicina Tactica España  


EPI Equipo Proteccion Indivual 

 GEOLOCALIZACION Desfibriladores 
Republica Dominicana 

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